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To review the various efferent visual system disorders associated with multiple sclerosis (MS).Studies have supported the use of internuclear ophthalmoplegia, a model to study effects of fatigue and heat in MS patients.There are a host of efferent ocular manifestations that can present throughout the course of MS. These may manifest as blurred vision, potentially misleading both the patient and clinician to suspect an afferent visual deficit. Other efferent symptoms include diplopia, oscillopsia, and vertigo. The efferent system can be divided into broad categories: supranuclear, internuclear, nuclear, and gaze-holding systems. This review will briefly touch on the anatomy as well as the signs and symptoms associated with MS-related dysfunction involving these systems.